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Assembly House O'Connell Street Waterford Tel 051 860700 www.southernassembly.ieEXECUTIVE PLANNER APPLICATION Formalization No. Please complete this form in TYPED BLOCK CAPITAL LETTERS: First Name:

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Souformrn Eastern Midland is a specific form used for reporting financial information related to the Eastern and Midland regions.

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Information such as revenue, expenses, assets, and liabilities must be reported on Souformrn Eastern Midland.

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